Sunday, August 16, 2009

26 comments:

That's cute, but do you really think the average Englishman gets the kind of medical care that he does? There's a reason Hawking gets the best possible medical care. It's an example of rationing. Some patients are considered worthier than others.

Steve, do you think anyone with Hawking's condition would have a prayer of ever getting private insurance?

This, to me, is the biggest argument in favor of reform and a public option: there will always be people with great health care needs who are uninsurable by private companies. What do you think should be done with such people?

Hawkings condition dates to his undergraduate days when he was an "average Englishman". Hawkings was not considered "worthier" than others. Hawkings was kept alive by the NHS for a long time before he was famous. Today, as far as I know, Hawkings still receives no more the NHS than any other Englishman; any "extra" care comes from non-government source and non-government funds. No plan being considered in the U.S. would prohibit such extra care from non-government sources.

Had Hawkings been covered by private insurance at the time of diagnosis, that company would have jumped over the moon in its efforts to drop his coverage. Certainly no private insurance in the U.S. would have lifted a finger for Hawkings after he was diagnosed as an undergraduate. No government health care, no Hawkings.

Steve, do you think anyone with Hawking's condition would have a prayer of ever getting private insurance?

This, to me, is the biggest argument in favor of reform and a public option: there will always be people with great health care needs who are uninsurable by private companies. What do you think should be done with such people?

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Since I'm uninsurable myself, due to preexisting conditions, I'm not unsympathetic to the concern.

However, as a number of critics (of Obamacare) have pointed out, if insurance companies couldn't exclude anyone on the basis of a preexisting condition, then no one would take out health insurance until they got really sick. They wouldn't be paying into the system. So insurance companies would go bankrupt.

I'd also point out that back when I was a kid (1960s), no one had health insurance. We didn't need it back then. Health care was more affordable. It was fee for service.

So instead of taking the status quo as a starting point, and simply extending the status quo to others (which is not cost-effective), we should begin by asking why the cost of health rises every year above the rate of inflation.

So to use Hawking as an analogy is a bit wide of the mark, yes? Your average Brit doesn't get those benefits, and it could be argued that the "extra help" is what pushes Hawking along whereas with your average Brit they in fact would be dead, or may as well be.

Oh, BTW, to say you would berate someone's reading comprehension skills if you were someone else is basically to berate the reading comprehension skills, albeit by hiding behind what you say another would do. Your feigned chivalry doesn't impress. Or, are you the final T-blogger cylon?

"You did read the bit about the extra care coming from non-government sources, yes? I believe at this point, if I was a T-blogger, I berate your reading comprehension skills."

Yes, I read it. And it undercuts your argument. By your own admission, public health care is insufficient to provide for his needs. He has to fall back on private resources to supplement what is lacking in public health care. Try to follow your own logic to its logical conclusion.

BTW, I happen to know, or know of, various individuals with personal experience of British health care. It doesn't make for pretty reading.

There's also this transparently fictitious notion that public healthcare can make affordable what is otherwise unaffordable to the general public. Well, gee, where do you think gov't gets its revenue in the first place? Public health care is just a case of the public writing itself a check. There's no savings.

Steve, if I understand it correctly, Obama's health care plan includes a mandate that everyone must purchase private health insurance. This would eliminate the problem you discuss of people only signing up for health care after they got sick. He addressed that specifically in a town hall meeting yesterday.

I believe this is how universal health care is achieved in Switzerland (or is it Sweeden?). They have universal coverage and a totally private health care system. Everyone there is required by law to purchase health insurance, and those who can't can apply for government aid to do so. That would be a win-win for everybody. No big government program, nobody getting a free ride, a big influx of cash to insurance companies, and everybody's covered.

But to take issue with other points you make, it's just not true that there are no savings in public insurance. The US private system costs 3 times as much per person as the public options in other industrialized countries. The reason for that is that people with private insurance in the US are already paying for the uninsured. With the public option, everybody is paying something, so the costs are spread out. With the US system, you have 70 percent of people paying not only for themselves but also for the 30 percent of people who aren't paying anything. When everybody's paying, everybody can pay a little less.

I'd also say that while I'm a liberal, I'd have no problem at all with some sort of sensible tort reform, since defensive medicine is certainly one of the reasons health care costs are going up. And I also don't know why competition across states is disallowed. I'd be in favor of those restrictions going, too. So, I think conservatives do have good ideas on this issue that should be included in the bill. That would be a better contribution than just yelling like a banshee at town hall meetings.

How does it undercut my argument? How does this lead to the conclusion that public health care is insufficient to provide for his needs? I thought we’re talking about the extras here.

Hawkings received care from the NHS for many years when he was just an average Englishman. The NHS did the job, it kept Hawkings alive. No government health care, no Hawkings. When Hawkings was an unknown, it didn’t favor others over him, and today, it doesn’t favor Hawkings over others.

The NHS also keeps alive others with his conditions. NHS care was sufficient for Hawkings and it’s sufficient for others with his conditions. I don’t know exactly, in detail, what the NHS provides, but it certainly sustains the lives of those who would not be sustained by private insurance. Any time private insurers want to step up and do the job, I'll applaud them for it. In the meantime, what are we to do about those with Hawking's condition?

Now, Hawkings can afford some extras, but how is this a strike against the NHS or an argument for less government involvement in health care? What exactly is your complaint or how exactly does the Hawkings case demonstrate a problem with government involvement in health care?

Do uou think that everyone with Hawkings condition should have motorized wheelchair with the ventilator, computer interface, voice synthesizer, and all the other accessories? So do I. How are we going to do this

“Steve, if I understand it correctly, Obama's health care plan includes a mandate that everyone must purchase private health insurance. This would eliminate the problem you discuss of people only signing up for health care after they got sick.”

That solves one problem by creating another. Like any investment, health insurance is a calculated risk. Does the potential benefit of coverage in case you might need it outweigh the downside of spending thousands of dollars a year, year after year, on something you may not need until a much later date?

From what I’ve read, a fair number of twenty-somethings and thirty-somethings don’t buy health insurance because they don’t think, statistically speaking, that it’s cost effective for them. And that’s a very rational calculation for them to make. By the same token, I expect some of them who are presently covered would like to lower the withholdings on their paycheck, but currently lack that option.

Gov’t has no right to coerce them into buying health insurance if they don’t want to, probably don’t need to, and could use that money (which is, after all, their own hard-earned money) on other things they need or want.

“The US private system costs 3 times as much per person as the public options in other industrialized countries.”

Well, what about that?

i) There are good reasons and bad reasons why health care is more expensive here. One reason is redundancy. We have more MRIs and other gizmos per capita than other countries. It might be more cost-effective to have fewer MRIs per capita. But, of course, there’s a trade-off: more people chasing fewer goods and services.

If Americans are prepared to pay for the convenience of having redundancy, why should gov’t deny them the right to do so?

ii) I also don’t know how you do the comparative analysis if you’re comparing out of pocket expenses (e.g. health care premiums, copays, deductibles) with socialized medicine subsidized by higher tax rates (e.g. Sweden).

iii) And, of course, there’s a tradeoff between cost and quality. To take two examples:

a) Canadians crossing the border to get timely services they can’t get in Canada. That’s hardly cost-effective for them. They are paying double. Supporting socialized medicine in Canada through their tax revenues while paying out of pocket in America to get what they need, but don’t receive in Canada.

b) What about the 15,000 French seniors who died in a heat wave back in 2003? That would be equivalent to 75,000 American seniors dying in a heat wave. Is that you’re idea of quality health care?

“The reason for that is that people with private insurance in the US are already paying for the uninsured.”

Of course, there are ways of changing that.

“With the public option, everybody is paying something, so the costs are spread out. With the US system, you have 70 percent of people paying not only for themselves but also for the 30 percent of people who aren't paying anything. When everybody's paying, everybody can pay a little less.”

i) Those currently without coverage would make greater use of medical services if it were more freely available–thus hiking the price.

ii) And don’t forget that the same number of doctors and nurses would be treating far more people.

iii) Obamacare would be a magnet for a new wave of illegal immigration. What’s the cost of that?

Saying you're not going to buy health insurance you don't think you'll need it is like saying you don't need to buy car insurance because you don't think you'll need it. The government still mandates that everyone who drives buys car insurance, because statistically speaking accidents will happen at a certain percentage and somebody is going to have to pay for it. In like fashion, a significant portion of 20 and 30 somethings will either become catastrophically ill or get in horrible accidents. And that's a cost that, eventually, has to be borne by the rest of us, either through higher premiums or higher taxes.

We have to do something. The empty mantra of "freedom" means little when we're facing a problem that's going to bankrupt us as a country. That's the issue in this debate: the liberals are dealing with hard, difficult facts, and the conservatives are dealing purely in abstracts. I've recently been quoted a statistic that says that health care in the US has an inflation rate of 40% every three years. In an ideal world, everyone would be free to do whatever they want. But this is not a perfect world. Whether these costs are because of redundancy or not, we can't survive as a country paying that much for health care. We have to do something to get costs down, and universal private coverage is one way to do it.

Further, it's not plausible that we've got 3 times as much of everything per capita as other countries have, because our quality of care compared to those other countries is extremely low, even when comparing people of similar ages with the same conditions. But even if it were true, if we have 18,000 people a year dying for lack of these redundancies, then what good are they doing? Besides, on the assumption that these redundancies exist, they won't disappear when universal coverage is passed.

On the issue of Canadians crossing the border, in real numbers, there are more Americans who seek health care in other countries than there are foreigners who seek health care here. And the Americans who seek health care outside of the country aren't paying double, they're paying many times as much as their counterparts. They first pay 3 times as much for their private insurance and then have to go pay out of pocket in another country (unless you think their private insurance is paying for procedures in other countries - in which case I have a bridge you may be interested in.)

The heatwave deaths in France aren't a result of bad health care it was a result of a lack of air conditioning. Most of those deaths occurred in private residences in areas of the country that are usually cool even in August, so many elderly people who never needed air conditioners were caught off guard and died in their homes. It takes a special kind of callousness to lay the blame for that on France's health care system. You're too smart to be lead around by the nose by Glen Beck et al on that particular talking point.

It's a fallacy to think that those without health insurance don't avail themselves of any health services at all. They do. They go to the emergency room. And then we pay for them. If coverage were universal, instead of congregating in emergency rooms and creating 6-7 hour wait times, these people would go to family practitioners. Thus I don't agree that there will be more people chasing the same number of services. I think there will be the same number of people seeking care from a more diverse group of providers instead of all congregating in the emergency room. There may be some short term glut but I have enough faith in the capitalist system that I don't think demand will exceed supply for very long. If there's lots of money to be made in the health care professions, there will be an increase in the number of health care professionals.

I don't know what you mean by "Obamacare". If the reform bill passed just mandates that everyone buy private health insurance (word now is that Obama is dropping the public option) how will that produce a wave of illegal immigration? Were a private option to remain on the table, remember that it would still require the payment of premiums. The public option would not be a single payer system financed by taxpayers. It would require people pay premiums and deductibles just like private insurance. The only thing it wouldn't do is reject people for pre-existing conditions. So I can't see how a public option would increase immigration. Even in single-payer systems like that in Canada, it is nearly impossible for a non-citizen to receive free care. It's difficult for non-citizens to even purchase cheap medication in Canada. The immigration issue is a red herring.

"Saying you're not going to buy health insurance you don't think you'll need it is like saying you don't need to buy car insurance because you don't think you'll need it."

That's hardly an intelligent comparison. The reason drivers are generally mandated to buy car insurance is because, in they injure someone else in a traffic accident, the medical bills of the injured second party will be covered.

"Up to 1974, I was able to feed myself, and get in and out of bed. Jane managed to help me, and bring up the children, without outside help. However, things were getting more difficult, so we took to having one of my research students living with us. In return for free accommodation, and a lot of my attention, they helped me get up and go to bed. In 1980, we changed to a system of community and private nurses, who came in for an hour or two in the morning and evening. This lasted until I caught pneumonia in 1985. I had to have a tracheotomy operation. After this, I had to have 24 hour nursing care. This was made possible by grants from several foundations."

"That's hardly an intelligent comparison. The reason drivers are generally mandated to buy car insurance is because, in they injure someone else in a traffic accident, the medical bills of the injured second party will be covered"

Steve, the reason the comparison is intelligent is because a statistically determinable amount of 20 and 30 somethings who don't buy insurance because they don't think they need it will require expensive health care before they purchase insurance. And if they don't pay into the system before that happens, the cost is borne by the rest of us. Thus, it is not just themselves they potentially hurt when taking this risk. They're gambling, but when the gamble fails, as it must and always will for a statistically significant portion of that age group, they aren't the ones who pay, we are. Thus, there is the same justification for requiring people to have health insurance as there is for requiring people to have car insurance: because it's not fair that the rest of us have to pay for the unnecessary risks that they take.

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About Me

I am the author of C. S. Lewis's Dangerous Idea: In Defense of the Argument from Reason, published by Inter-Varsity Press. I received a Ph.D in philosophy from the University of Illinois at Urbana-Champaign in 1989.